When most people take a cruise they focus on the fun, the sun and the food. But here’s another thing to think about: sanitation. Poor sanitation can ruin your cruise — ask anyone who’s been felled by a norovirus. And the biggest culprit? Fellow passengers who don’t wash their hands. Yes, you read that right: Passengers can make a ship sick.

Sailor’s enemy

There’s nothing worse than getting sick on your cruise vacation. Seasoned travelers know all too well the importance of watching what they eat and washing their hands: It keeps the bugs at bay. Still, some of our fellow travelers aren’t so vigilant about hand washing, and they put us all at risk.

Poor personal hygiene habits can spread one of travelers’ worst enemies: noroviruses, also known as Norwalk virus and NLV, a group of viruses that can cause severe diarrhea, nausea and vomiting over a 48- to 60-hour period. According to the Centers for Disease Control and Prevention (CDC), noroviruses are highly contagious and can be passed directly from person to person as well as through tainted food and water. While the majority of patients recover with no lasting effects, the illness can be a more serious problem for infants, elderly people and people with weakened immune systems.

The risk of contracting a contagious disease like norovirus illness is particularly high on a cruise ship because passengers mingle in a relatively confined space. For this reason, all cruise ships that dock in the United States and travel to foreign ports undergo regular inspections by the CDC’s Vessel Sanitation Program (VSP). U.S.-based ships that do not make foreign port stops, such as Norwegian Cruise Line’s America fleet, which cruises around the Hawaiian Islands, are given similar inspections under the U.S. Food and Drug Administration’s Interstate Travel Program.

All this inspecting is both reassuring and alarming, and wise travelers take their own precautions against picking up nasty germs at sea.

Sick at sea

This week passengers onboard Royal Caribbean’s Majesty of the Seas became sick with a stomach illness, according to a company officials. Royal Caribbean stated that 66 of the more than 2,500 passengers aboard experienced gastrointestinal issues, such as vomiting and diarrhea. What starts all this – to put it bluntly from a CDC official I interviewed several years ago – lack of hand washing.

America’s dirty little secret

The American Society of Microbiologists commissioned a
survey on the nation’s hand-washing habits. Observers sent into public restrooms to observe 6,336 adults found that only 82 percent actually washed their hands after using the facilities. Women were more diligent than men: 90 percent of the ladies washed their hands, compared with only 75 percent of the men.

Itinerary can affect the incidence of shipboard illness; for example, in past instances the CDC has noted special problems with cruises beginning in Mexico. Of particular concern are passengers who have arrived in the country a few days before boarding the ship; the suggestion is that these travelers pick up the virus on land, then bring it onto the ship when they board.

In a nutshell, people board their cruise with the virus. On a cruise ship, people are out and about in very public areas, and so opportunities abound with infected passengers depositing of the virus on various surfaces that then would be easily picked up by others.

If passengers think they are ill they need to avoid contact with other passengers and to report to the ship’s medical facility immediately. Of course, most passengers don’t want to be quarantined in their cabins so the virus keeps spreading around the ship, creating a sometimes chronic problem.

Inspectors aboard

The cruise lines’ defense against viral and bacterial illnesses is constant vigilance, strict sanitation control and regular disinfection. To keep them on their toes, the CDC conducts unannounced inspections of each ship twice a year. This cooperative effort is the chief reason there aren’t bigger outbreaks of illnesses at sea.

The CDC’s inspections are rigorous. Each inspection takes six to eight hours, depending on the size of the ship and the number of inspectors. The inspectors use a checklist to help evaluate such things as the ship’s water supply, food storage practices and food-preparation areas. Every ship starts with 100 points, then loses points for each infraction.

It doesn’t take much to lose points — anything from cracked tiles to refrigerators that aren’t quite cold enough. Inspection scores from the mid-80s to mid-90s are the most common. Ships scoring 86 points or higher are considered satisfactory; those scoring 85 and below are reinspected within 30 days.

Ounce of prevention

The CDC believes that noroviruses are becoming more virulent. And while noroviruses worry ship doctors a lot, they are a bigger problem on land than at sea. The statistical reality is that a miniscule percentage of all cruise passengers worldwide have become infected with a norovirus. Still, you don’t want to find yourself in the sick bay, so how can you protect yourself?

Remember what your mother told you: Wash your hands. For best results, the CDC recommends using warm water to moisten your hands before applying soap. Rub your hands together vigorously for at least 20 seconds. It is the soap combined with the scrubbing action that loosens and removes the germs from your hands.

That’s all there is to it: Twenty seconds of insurance that can literally save your health and your cruise.